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595 Septic application, perit and plans 2000 Appli COO OIN'Ii Uth OF MASS/VA-FUSEE Board of Health NOIZTHA yc ON . ALl. M ON RV DISPOSAL SYSTEM CONSTRUCTION N NMT FEE72 CS) Location ` c"-eS Md9'DOw RD '' , : O N'amf R 0 N 6^^cI' .._c Address 2 S S LVI A fi' 15 — PIA Q.L'-/ Map/Parrrl# s Lot# 5 Telephone-it S€11-1 Install 's Name tr e / l.�(, C i e`(F D g `s Name-'en alh MARGiuJJ)S hl, Address t-1 r: / `t F.- l.e y Address 00 AA oellmGvE 2 -(S NHnf Telephone# - Telephone# (4 t3) CC 21 - 5- L q Type of Building Dwelling-No.of Bedrooms 4^ Other-Type of Building No.r if persons a Other Fixtures SIIQ 6t—L FRMity Iva Size sq.ft. Garbage grinder 4-Y Showers(i),C,L .;a ( ) Design Flow(min.required) *40 gpd Calculated design Bow 6(00 Plan: Date I I'2_O 00 Title Desutiption of Soil(s) 5 (2.10Iw Awl Cow `low,: A-A.A Number of sheets Design Flow provided 7/200 gpd Re'i.ion Date Soil Evaluator Form No. Name of Soil EvaluatorQsbACENQSe- Date of Evaluation 4-/S-00 DESCRIPTION OF REPAIRS OR ALTERATIONS .The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the s ystem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date .Inspections No COMNIONWLALTB Of MASSACULS .ITS 14. . MA. CPIII:IC, TL Of CON'TPLIANII ent(s yy,�Complete System Abauduved ( 1 The undersigned he J Ind i that Comp i /"t pg,ided The unde g d hereby e u[ t the Se gc Disposal Si stem. Gonni t r' d i.Repo t 1 l 1.0 i 6 ,r 1;- F 1 -with the provisions has been installed u " _Ap "/ dated application - 77,-. Installer s -.% !' i I _ Dote: The issuance ante that the ry tem will function as designed. The issuance of this permit shall not be construed as a gum' r COMMON t'LADI1 Of ' SSNC1113MS / FEE .MR 15.00 (Title ) and the a p vol design plan Approved Deb Fl■w %r Do ISpd) Boom'ty Health A '7? t frh DISPOSAL SYSIDI CONSeTPUCTION pUUM1"I ) Abandon( ) an individual sewage disposal system permission is hereby gran¢ed m; Con.tract) Repair) Upgrade( � r iJ as described in the application for �. fs �1pF-�/i'� t D !7/�� dated " Disposal System Construction Permit No. �' t n. All loci}concur must be met. �ovided: Con saucdo°shall he completed .// r 6: / years of the date of this ffig Date C / Board of Health -� g Rev 5E6 AM9vYrin W.BO9oe MA buip pl lug to PE OR PRINT ONLY Massachusetts Department of Environmental Management Office of Water Resources Well Completion Report 103752 :VOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. r 1.WELL LOCATION I GPS (OPTIONAL) LATITUDE LONGITUDE Address at Well Location 3RR3 COa S --?='J'*' Property Owner: ---unite -ui1-^2r5 Subdivision Name' Mailing Address' 25 Sylvia He_ :. is Oily/Town. YO Ltd..Dion City/Town• :aCaej Pit 31 :135 Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if no street address available Board of Health permit obtained: Yes ■ Not Required g Permit Number Date Issued 2 WORK PERFORMED ": 3. PROPOSED USE &DRILLING METHOD . © New Well O Abandon O Deepen C Recondition C Replace M Other 0 Domestic ■ I rigation C Monitoring C Municipal O Industrial O Other O Cable C Auger El Air Hammer C Direct Push ❑ Mud Rotary C Other ..WELL LOG . u- Cr W Q 3 P By Unconsolidated Consolidated &SITE SKETCH(uw P.w.nenn.mWtu daps) From (H) To (ft) a v = 1O °_ w _ m a a � Other Rock Type with �?0' C-G-5T !c4 Cc(e._. A'�: - I /�� �. ' r High Low 3 2 1;raloil Pi_., I / 7.WELL CONSTRUCTION B.CASING Total Depth Drilled 440 F cm (ft) ,_%Jo (ft) Casing Type and Material Size O.D. (In) Well Seal Type Date Drilling Complete t.-? t -31 i - r d St:aei __.sin; 5" Drives_oe 9. SCREEN From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter 1 10. FILTER PACK 1 GROUT/ABANDONMENT MATERIAL 11.ADDITIONAL WELL INFORMATION From (ft) To (ft) Material Description . . Purpose Developed? C Yes C No Fracture Enhancement? 2 Yes C No Method N,+Tt nil,.c-+-' .<-� _ Disinfected? l Yes U No 12. WELL TEST DATA (PRODUCTION WELLS) 13.STATIC WATER LEVEL(ALL WELLS) Yield Time Pumped Drawdown to Time Recovery to Date Method (GPM) (hrs & min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Depth Below Ground Surface (FT) co 14. PERMANENT PUMP(IF AVAILABLE) 15.NAME/ADDRESS OF PUMP INSTALLATION COMPANY ,1 c r ,> c-rrr Horsepower�sn Pump Description .Sr. �,�.0 Pump Intake Depth -7P--C (ft) Nominal Pump Capacity 8 (gpm) 16. COMMENTS I /' 17. WELL DRILLER'S STATEMENT IThis well was drilled_grld/or abandoned under my supervision, according to applicable rules and regulations, and this repoot is cgmplete and cor ect to the best of my knowledg22 �J _i 1 13 I ° 13 I Driller '"r J1pD"-- Supervising Driller Signature'. �' - ` /�_ Registration Firm: -Kr 4'I yy , / . - _ I`` i. Date' rc � Rig Permit 4: i -1 � ,i :VOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. r • Sampled 8337 1 HOWARD LABORATORIES OF NEW ENGLAND, INC. 750 North Pleasant Street Amherst, MA 01002 Phone: (413) 549-8260 Fax: (413) 549-1850 MA Lab License. M-00851 WATER ANALYSIS REPORT Analyzed For: Bercume Builders Address: 25 Sylvia Heights Hadley, MA 01035 Telephone: Sample Location: 595 Sylvia Heights Lot 5 iV�jpp. Hadley. MA Sampled By: HW D Date Sampled: 6/27/01 Date Received. 6/28/01 PARAMETER Total Coliform Bacteria RESULTS LIMITS COMMENTS PH Manganese 0 Commas/troml 0 Commesu IWmr 7.16 pH um 0.047 mg;; 6.5-g.5 pH c 005 mg/I OK OK OK Hardness 88 me Conductivity 0.11 ms/_m Chloride 11.6 ins Nos <5)SOFT, >000 HARD 2$C mg.' No Sunda OK Iron 0.16 mgn 03 mgn OK Sodium 1 24 mpg Nitrate 0.4 mgn myll Nitrite 0.002 mot gal I OK OK OK Colo 100 P;CC Calor Umu 15 PMO CoIr Unit; Turbidity 31.7 left Recommendations: See enclosed MA DEP Interpretations sheer for parameter nke with a azersk This sample meets acceptable standards of potability for the parameters tested. except for those parameters marked with an asterisk (") Analyst- BA Checked By Jonathan S. Beg Laboratory Supervisor Date: 6/28/01 NO2'30'43'V 27 0.0 0 n APPROX. Nse. LoCAM N23. 9 ------4 20:31 n m [ S A.5. to y A PPRox. i W C. N S. \n S n1 _ , J f(•yQ A1 . , Fa irlA : DEN Il8 P LRCJUFiSE • PHONE NL. 413+296+4:EB `1o•.). OE 2900 10:44P11 Pi No.: Date: Apr11,1996 Commonwealth of Massachusetts Aloo\,, CSmpkr, , Massachusetts Site Suitability Assessment for On-Site Se_wage Disposal Performed By:. Uerras a,A..c sr Certification Number if/95- Witnessed By' 110}ee Loca::on Address or Lot No.: L Owner's Name, Address and Tel.q: kon ZerC3avnE 'J.5 C.iI J;4 \-V,y,y5 triaelv,.t,Mh 0,035 New Construction Igf Repair 7i Office Review Published Soil Survey Availabie: No ❑ Yes 21 Year Published $1 Publication Scale If ISVi Soil Map Unit !O/CRC Drainage Class wrM Soil Limitation Slope Suite' Ceologlc Report Available: No yr' Yes 7 year Published Publication Scale ` Geologic Material (Map Unit) Landforrn ti.rw-,n lin Flood Insurance Rate Map: Above 500 year flood boundary Nc ❑ Yes 2, Within 500 year flood boundary No �i Yes ❑ Within 100 year flood boundary No ® Yes 0 Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Mariam <,OC Range: Above Normal ❑ Normal IX Below Normal ❑ Other References Reviewed: ,FNJH : DE HIS P LfC.UP'SE • PHONE N0. 413+296+43E2 Nov. OE 2000 13:46'N P4 On-Sit___e Riew Ceeo Hole Numder 1 Date a/13/00 Tune 9'PS Weather deetr Location (Identity on site plan, Land Use fQSkn• p1 Slope(%) "3- Surface stones !C rU Vegetation Lute&I .kia Lancionn fia-VOYl14■ Distances from: Open Water Eoay `aiOC3 F feet nrainageway Acrid feet Possible Wet Area 'aO fl F feet Property Line SC) feet Drinking Water Waii n Jot feat Omer DEEP OBSERVATION HOLE LOG Ceot from Swfecs Soil Mormon ,°noses) Sou Texture (USCA) Son Color ,Mrrseli) So.i Matr.rq Jon 5:C nset Stores. raveers, Gore�tency.Y.Grawil 0 TO Cf iA SA CV R SAS, vtc sbnQ,ccara, II TO ac �w SL i(Jvs t''/ Ci rwi 5)er es,¢e+da, prtaole,reoLs tKo TCe i-G G vr./s %.SYR '4j4 o -Sa" cer..ce4\-eck pt,,,,, redge+ib, < +es,Eresate Parent Material (geologic): b--l+.)OS" Depth to Bedrock 2epth to Groundwater_ Standing Water in the Hole:no n C Weeping from PA Face awn z Eetimateci Seasonal High Ground Water 53 ,FROM : DENNIS R LROURSE PHONE NJ. 413+296+43E2 4v,. BE 26@O 1u:4.T=r4 P2 On-Site Review Ceec Ho:e Number a Cate_ =?b33/00 „m• q:4S Wea•`.e, Cif4,' .ccacicn(identify on site plan Land Use recsiriteikt( Slope ■%) "a. Surface•:ones ID Ho '✓ege2^On A�w ew crA 16‘414 1ancrorn tN +An ■ ■ Distances from: Open Water Sooty '208 4- feet Dra:nageway f' a teat PassibleWet Area .-CC * feet Property Lire W: feet Drinnira Water VW'el' 11/Ol feet Other DEEP OBSERVATION HOLE LOG ]earn non aur`aca (inches, Sod-t^::n. 1 5011 Taxture USCw1 944C.4r Sed Mcmw. Omer (NVS6t0 Crcwre.Stores.aeuders. C91Aeteney, %Graven "Vs YCa- s■tneicabbEs, bate rrn,5bne5,Ccbbis ;no) , aeo'5 7. ati 'fib' F�Yflr fei4anc-j ter..e-Wei Cobin:es Friable Parent Material (geeloeto; Ocii was k Depth to Bedrock aaW` Death M lrrgundWa;ec Standing Water in the Hole: .umoS. Weeping from Pit Face: hen C Estimated Seasonal High Ground Water:70" ,FROM : DBMS R LRCOLFSE • PHONE N7. 413+266+43E2 Ja]. 06 2000 10:47PM P5 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. E. C Xc' i'tkaa.•.a rE� Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches X Depth to sod mottlesSS!70 inches ❑ Ground water adjustment • . .. feet Index Well Number _... Reading Date .. Index well level Adjustment factor __.. Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at feast four feet of naturally occurring pervious material exist In al! areas observed throughout the area proposed for the soil absorption system? yos If not, what is the depth of naturally occurring pervious material? Certification I certify that or �/i9s (date) I have passed the sail evaluator examination approved by the Dep rtment of Environmental Protection and that the above analysis was performed by me consii$ nt with th- re. .'red training, expertise and experience described in 310 CMRit 1 "" 017. C e Arl✓S„✓, _, Date WI .//00 Signatur LEP APPROVED F)ICI 12.4'eF .Rar9 DENJIS R LRCJURSE PHONE N9. 413+236+43E9 Joy. 9E 2990 10:4EDM P3 FORM 12 - PERCOLATION TEST aR 1 'p Location Address or Lot No 3 cot /+1P9tpC.v COMMONWEALTH OF MASSACHUSETTS ,Qeu-ki „14-o,,, Massachusetts Percolation Test Date: gl1/43/00 Time:. r:0,6— . Observation Hnle # 'a. Depth of Perc Start Pre-soak 'l%aa IG: Or End Pre-soak ?: 3 7- IC: 16 Time at 12" t�•Cii :0: 17 Time at 9" 'l:sr 10: -3-$ Time at 6" l D:07 lo : Sr Time i9"-5"1 a,r G ruin. Ar. a3 rv.;v■■. q ,-,:v,. /ie.. Rate Min.finch Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed a Site Failed U Performed By: 'Dennis R. Lacowsa Witnessed By: ' e-e.f AcGrkifr Comments: DEP APPROVED rotM.cMnf F=20. : DENNIS P EFICOUPSE • PHONE NJ. : 413+296+4366 Nam, 06 2000 IE:45'M P5 1,07- 10 a